Active NPI
Kenneth Douglas Gade
- Pharmacist
- Navarre, FL
National Provider Identifier
1790054740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS20617
- Practice address
- 8220 Navarre Pkwy
Navarre, FL 32566-6943 - Phone
- (850) 936-4302
- Fax
- (850) 936-4358
- NPI assigned
- Dec 20, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS20617 | FL | Primary |
| Geriatric Pharmacist | 1835G0303X | PS20617 | FL |
Addresses
Primary practice location
8220 Navarre Pkwy
Navarre, FL 32566-6943
Mailing address
8220 Navarre Pkwy
Navarre, FL 32566-6943
Phone (850) 936-4302
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS20617 | FL | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324339200000",
"number": "1790054740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8220 NAVARRE PKWY",
"city": "NAVARRE",
"state": "FL",
"postal_code": "325666943",
"telephone_number": "850-936-4302",
"fax_number": "850-936-4358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8220 NAVARRE PKWY",
"city": "NAVARRE",
"state": "FL",
"postal_code": "325666943",
"telephone_number": "850-936-4302",
"fax_number": "850-936-4358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GADE",
"first_name": "KENNETH",
"middle_name": "DOUGLAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-20",
"last_updated": "2011-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS20617",
"primary": true
},
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "FL",
"license": "PS20617",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Navarre, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.